EP2509507B1 - Combination of ultrasound and x-ray systems - Google Patents

Combination of ultrasound and x-ray systems Download PDF

Info

Publication number
EP2509507B1
EP2509507B1 EP10805324.0A EP10805324A EP2509507B1 EP 2509507 B1 EP2509507 B1 EP 2509507B1 EP 10805324 A EP10805324 A EP 10805324A EP 2509507 B1 EP2509507 B1 EP 2509507B1
Authority
EP
European Patent Office
Prior art keywords
ultrasound
probe
ray
ultrasound probe
ray image
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Active
Application number
EP10805324.0A
Other languages
German (de)
English (en)
French (fr)
Other versions
EP2509507A1 (en
Inventor
Nicolas P. B. Gogin
Raoul Florent
Pascal Y. F. Cathier
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
Koninklijke Philips NV
Original Assignee
Koninklijke Philips NV
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Koninklijke Philips NV filed Critical Koninklijke Philips NV
Priority to EP10805324.0A priority Critical patent/EP2509507B1/en
Publication of EP2509507A1 publication Critical patent/EP2509507A1/en
Application granted granted Critical
Publication of EP2509507B1 publication Critical patent/EP2509507B1/en
Active legal-status Critical Current
Anticipated expiration legal-status Critical

Links

Images

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/12—Arrangements for detecting or locating foreign bodies
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/52—Devices using data or image processing specially adapted for radiation diagnosis
    • A61B6/5211—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data
    • A61B6/5229—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image
    • A61B6/5247—Devices using data or image processing specially adapted for radiation diagnosis involving processing of medical diagnostic data combining image data of a patient, e.g. combining a functional image with an anatomical image combining images from an ionising-radiation diagnostic technique and a non-ionising radiation diagnostic technique, e.g. X-ray and ultrasound
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/42—Details of probe positioning or probe attachment to the patient
    • A61B8/4245—Details of probe positioning or probe attachment to the patient involving determining the position of the probe, e.g. with respect to an external reference frame or to the patient
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/44—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device
    • A61B8/4416—Constructional features of the ultrasonic, sonic or infrasonic diagnostic device related to combined acquisition of different diagnostic modalities, e.g. combination of ultrasound and X-ray acquisitions
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B6/00—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment
    • A61B6/50—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications
    • A61B6/503—Apparatus or devices for radiation diagnosis; Apparatus or devices for radiation diagnosis combined with radiation therapy equipment specially adapted for specific body parts; specially adapted for specific clinical applications for diagnosis of the heart
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B8/00—Diagnosis using ultrasonic, sonic or infrasonic waves
    • A61B8/08—Detecting organic movements or changes, e.g. tumours, cysts, swellings
    • A61B8/0883—Detecting organic movements or changes, e.g. tumours, cysts, swellings for diagnosis of the heart

Definitions

  • the present invention relates to x-ray guided procedures. Especially, the invention relates to a method for processing an x-ray image. Furthermore, the invention relates to a system comprising an x-ray system as well as an ultrasound system, wherein the system is equipped with a computer program for performing the method.
  • One of the challenges of image-guided medical and surgical procedures is to efficiently use the information provided by the many imaging techniques the patient may have been through before and during the intervention.
  • a solution consists in using a second imaging modality which is both 3D and able to image soft-tissues.
  • This second imaging system is 3D ultrasound imaging.
  • the advantage of this modality is that it can be used in real-time during the surgical procedure.
  • trans-esophageal probes can be navigated right next to the heart, producing real-time volumetric images with anatomical details that are hardly visible with standard transthoracic ultrasound.
  • Typical interventions currently involving this modality combination are ablation for atrial fibrillation, PFO closure (or other septal default repair), and percutaneous valve repair (PVR). All those interventions are x-ray centric, but in all of them, the simultaneous involvement of ultrasound is either very helpful or completely mandatory to monitor the placement of the tool/endoprosthesis with respect to the soft-tissue anatomy.
  • the ultrasound probe can deliver very useful images of the anatomy, an important drawback is the compromise that exists between the temporal acquisition frame rate and the extent of the field of view. It is therefore necessary to have a small field of view to acquire images at high frame rate.
  • a volume with a large field of view is first acquired and is used to select small sub-regions within this first acquisition corresponding to the area of interest.
  • the area of interest would include the interventional tools or some of them. So in practice, the acquisition volume could be targeted around the interventional tools.
  • the interventional tools cannot be easily visualized in ultrasound due to artifacts (acoustic reflections, shadows, etc.) and limited spatial resolution.
  • Ultrasound through x-ray registration is usually performed using image-based registration techniques aiming at lining common structures visualized by both modalities. This approach has several drawbacks.
  • TEE trans-esophageal echocardiograms
  • natural landmarks such as the heart contours cannot be used because they are not visible in x-ray.
  • interventional tools as registration landmarks is challenging as they are not well defined in the ultrasound volume due to noise and artifacts.
  • Ultrasound to x-ray registration can also be achieved using tracking systems which give the position of the ultrasound probe with respect to the x-ray imaging system.
  • the ultrasound probe does not come with a standard tracking system that could be attached to the x-ray imaging system.
  • Many systems have been designed to gap that void using physical trackers such as magnetic devices. These systems may be expensive and have several disadvantages: they can be disrupted by interference and require additional calibration steps which are prone to error.
  • Document US2009/0185657 discloses a method for geometric registration of a radiation device and an ultrasound emitter emitting fan-shaped signals within an object.
  • the position of the emitter fan can be calculated from the position of the device.
  • two imaging modalities can be registered with one another, enabling, for example, a merging of the images generated by the two modalities.
  • Document US 2007/0276243 discloses a system for guiding a medical instrument in a patient body.
  • An ultrasound probe placed on the patient body may be localized within the X-ray referential (reference coordinates).
  • a bimodal representation of an ROI around a medical instrument is generated by combining the 2D X-ray image and a 3D ultrasound dataset of the ROI.
  • the ultrasound probe localization is based on an active localizer e.g. an RF coil. Based on the RF signal, the position and orientation of the ultrasound probe in the X-ray referential can be determined.
  • the article "Computing intraoperative dosimetry" by French et al. discloses registering transrectal ultrasound (TRUS) and fluoroscopy images using a fluoroscopic image of the TRUS probe. From this image, corner points of the TRUS probe artefact are determined, which are subsequently used to determine certain offsets between the fluoroscopic image and the TRUS image.
  • TRUS transrectal ultrasound
  • the present invention is defined in the independent claims 1, 11 and 12. It is an object of the invention to provide a system and method for a combination of ultrasound and x-ray images.
  • this is achieved by a method for a combination of ultrasound and x-ray images, comprising the steps of receiving an x-ray image, detecting an ultrasound probe in the x-ray image, and registering the probe including an estimation of a position and an orientation of the probe relative to a reference coordinate system.
  • the reference coordinate system may be any pre-determined coordinate system.
  • the reference coordinate system may be within the plane of the x-ray image or may be defined relative to the C-arm of an x-ray system which may be used while performing the method.
  • the method comprises further a step of matching a digitally rendered projection of a 3D model of the probe with the detected probe in the x-ray image, wherein the estimation of the position and orientation of the probe is retrieved from the 3D model of the probe.
  • the 3D model is retrieved from a CT acquisition or is a computer-aided design model.
  • a 2D x-ray image of an ultrasound probe may be registered with a 3D model of the probe which can be either a 3D acquisition of the probe or a computer-aided design (CAD).
  • CAD computer-aided design
  • This registration is performed by matching a digitally rendered radiograph of the probe and the real x-ray projection of the probe.
  • a graphic processing unit (GPU) based algorithm may be used to generate digitally rendered radiograph in an efficient way.
  • the 2D-3D registration of the ultrasound probe gives the 3D pose of the probe with respect to the x-ray imaging system.
  • There are several interesting applications such as merging the ultrasound image with x-ray image or ultrasound volume compounding in order to build an extended field of view.
  • the method may further comprise a step of visualizing an acquisition setting of the probe in the x-ray image.
  • the operator can easily adjust the acquisition settings thanks to the information visualized in x-ray. It provides an interactive way to change the acquisition settings of the ultrasound acquisition system during an interventional procedure.
  • the acquisition setting may be the field of view of an ultrasound probe.
  • the volume of the field of view of the ultrasound probe can be represented as a truncated pyramid in 3D. This pyramid may be indicated by the outlines of an area which can be visualized by an ultrasound system. Further, the pyramid may be defined by its centre together with parameters like the distance to the ultrasound sensor of the probe, a width, length, angle and/or a depth of the pyramid.
  • the volume of the field of view may also be a truncated pyramid in one plane having a constant thickness perpendicular to said plane. With an appropriate calibration, the truncated pyramid can be projected and displayed in the x-ray image. As the operator changes the acquisition of the probe, the display of the acquisition volume in the x-ray image is automatically updated to provide a direct feedback to the operator.
  • one or more parameter like a main direction, an angle, a distance, a frame rate or a coordinate system, may be visualized in the x-ray image.
  • the visualization of such parameters may be provided by for example points or lines or by numerals at an appropriate position in the x-ray image.
  • a main direction may be a direction perpendicular to the surface of the ultrasound sensor or sensors at the ultrasound probe.
  • a distance may be the distance of the ultrasound sensor to the center of the field of view or to a center of a reference coordinate system or to an interventional device also visible in the x-ray image or to any other predetermined point in the x-ray image.
  • This may allow for an interactive adjustment of the acquisition settings of the ultrasound acquisition system, through direct visualization in an x-ray acquisition system. By way of this, it may be easier for a clinician to adjust the orientation of an ultrasound probe relative to an interventional device like a catheter, wherein this catheter may be located within the truncated pyramid, i.e. within the field of view of the ultrasound probe.
  • the method further comprises the step of detecting an interventional device in the x-ray image and manipulating the probe so that the interventional device is within the field of view of the probe. It is noted that this manipulation may be performed manually as well as automatically.
  • an interventional device in 2D x-ray image and to steer an ultrasound probe beam towards this device.
  • the field of view of a probe can be automatically steered, and additionally the appearance of the intervention device in the fluoroscopy may be modified by for example blinking, flashing or coloring, when the device or at least a part of the device enters or is present in the field of view of the ultrasound probe.
  • the visualization will be enhanced and will dramatically help the steering of the ultrasound probe beam in the interventional context.
  • the method may further comprise the step of overlaying an ultrasound image provided by the probe over the x-ray image. Furthermore, it may be possible to overlay a plurality of ultrasound images over only one x-ray image. This may provide for an extended field of view.
  • interventional device may be a flexible or stiff catheter or a biopsy device, a canula or trokar.
  • the ultrasound probe may also be a trans-esophageal echocardiography ultrasound probe.
  • a computer program is provided by means of which the above described method may be performed automatically, or at least predominantly automatically. Therefore, the computer program comprises sets of instructions for storing a x-ray image generated by an x-ray system, sets of instructions for detecting an ultrasound probe in that x-ray image, and sets of instructions for registering the probe and thus estimating the position and orientation of the ultrasound probe relative to a reference coordinate system. Furthermore, the computer program may comprise sets of instructions for receiving data representing a 3D model of the ultrasound probe.
  • Such a computer program may be implemented according to a further embodiment of the invention in a system including an x-ray system, an ultrasound system with a ultrasound probe, and a processing unit.
  • a system will include also a monitor for a visualization of the ultrasound as well as the x-ray images.
  • Such a computer program is preferably loaded into a work memory of a data processor.
  • the data processor is thus equipped to carry out the method of the invention.
  • the invention relates to a computer readable medium, such as a CD-ROM, at which the computer program may be stored.
  • the computer program may also be presented over a network like the World Wide Web and can be downloaded into the work memory of the data processor from such a network.
  • Figure 1 shows, from left to right, an x-ray target image of an ultrasound probe, a non-aligned digitally rendered radiograph (DRR) of an ultrasound probe, as well as an aligned DRR.
  • DRR digitally rendered radiograph
  • the 3D model of figure 1b is orientated so that a projection thereof matches with the projection of the probe in the x-ray image of figure 1a .
  • FIG. 2 shows such an overlay of an aligned DRR 110 on top of an x-ray image of chest 300 and heart 320, after intensity based registration, i.e. an estimation of the position and orientation of the probe. This gives the position/orientation of the probe with respect to the x-ray imaging system. If both systems are calibrated, the ultrasound image can be merged with the x-ray image. Also shown in figure 2 are interventional devices 200, for example catheters. A coordinate system in front of the ultrasound probe 110 indicates the estimated orientation of the ultrasound sensor elements relative to the image plane of the x-ray image.
  • An x-ray acquisition system is configured to produce real-time 2D x-ray images of an anatomical region during an interventional procedure. This modality does not allow clear visualization of complex soft-tissue anatomy such as the heart.
  • An ultrasound acquisition system with for example a trans-esophageal echocardiography (TEE) ultrasound probe, is configured to produce images of the anatomy.
  • This ultrasound acquisition system is assumed to lie at least partially in the field of view of the x-ray acquisition system with sufficient information that it is enough to recover the coordinate system of the images produced by this system. It is the case for example when the whole detector of the ultrasound acquisition system is present in the x-ray image and/or when its position can be estimated from other structures present in the x-ray image.
  • TEE trans-esophageal echocardiography
  • a 3D model of the ultrasound probe may be used to automatically compute the pose of the probe. This may be done by matching the x-ray image of the ultrasound probe with a digitally rendered radiograph generated by transparent projection of the 3D model (cf. figures 1 and 2 ).
  • An optimization algorithm allows retrieving the 6 pose-parameters of the probe which gives the 3D position of the probe and its 3D orientation with respect to for example the C-arm system defining a reference coordinate system.
  • the volume of acquisition 130 of the ultrasound probe 110 may be represented as a truncated pyramid in 3D, assuming that the position and orientation of the ultrasound probe 110 with respect to the x-ray image is known.
  • an interventional device 200 with its interventional end portion may be located such that the field of view 130 encompasses that interventional end portion of the device 200.
  • an angle 140 determining the angle of beam of the field of view of the ultrasound probe.
  • the angle of beam is 42,3 degree.
  • FIG 4 is a flow chart showing the steps of a method for a combination of ultrasound and x-ray images according to the invention.
  • the patient is simultaneous imaged by an ultrasound system 100 and an x-ray system 400.
  • a considered ultrasound probe of the ultrasound system 100 is capable of generating synthetically steered beams, preferably in 3D.
  • step S1 the ultrasound system 100 and the x-ray imaging system 400 are first mutually registered. This can typically be achieved by imaging the probe of the ultrasound system 100 by the x-ray system 400, and based on the settings 150 and data 160 of the ultrasound system 100 and on the settings 410 of the x-ray system 100, plus on the possible use of a probe 3D model 500 or markers, in determining the position of the probe in the x-ray referential. From this information, and based on the relevant calibration information, one can use the parameters of the probe field of view in the x-ray referential, as described above. Data S1c will be exchanged for visualization of the resulting image.
  • step S2 at the same time, the intervention device (for instant the tip of a catheter), is detected and tracked in the x-ray images.
  • This step relies on data 420 of the x-ray system 400 and on usual object detection means that rely on the spatial signature of the device and possibly on its motion characteristics (for instance, the device is animated by a cardiac motion plus a steering motion, seen in projection).
  • step S3 it is advantageous to improve the 2D location provided by device tracking in the x-ray images and to try to get a depth estimation of the considered device.
  • Several approaches are possible to reach the goal, among which the exploitation of the devices observed width, the use of other x-ray views under different angulation for instance in bi-plane context or the use of wiggling motions.
  • the width of the ultrasound probe may be estimated, wherein subsequently possible locations of the ultrasound probe are discriminated on the basis of the estimated size and of a segmentation of the imaged object.
  • step S4 the device-improved location S3a can then be compared to the found ultrasound field of view S1b, and several commands can be issued accordingly. For instance, a device flashing/blinking command can be issued to the imaging processing channel of the x-ray data stream, or a probe steering command S4a can be sent to the relevant module.
  • step S5 i.e. the visualization of the device in the x-ray image which is adapted based on events such as the entering (blinking/flashing) or the presence (coloring) of the device in the ultrasound field of view.
  • This provides the ultrasound user with an easy way of controlling the steering of the probe based on the high resolution x-ray images. Of course, this steering is also made easier by the visualization of the ultrasound cone as shown in figure 3 .
  • the result of step S5 is an enhanced 2D view S5a facilitating the steering of the ultrasound probe.
  • a command S6a can be issued to the beam-steering module of the ultrasound system 100, as to which field of view one should generate in order to nicely visualize the device at the center of the ultrasound cone (volume or image).
  • the probe steering module based on the ultrasound/x-ray registration information will determine and apply the relevant set parameters enabling this device-driven steering.

Landscapes

  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Engineering & Computer Science (AREA)
  • Medical Informatics (AREA)
  • Pathology (AREA)
  • Animal Behavior & Ethology (AREA)
  • Radiology & Medical Imaging (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Biophysics (AREA)
  • Molecular Biology (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • General Health & Medical Sciences (AREA)
  • Public Health (AREA)
  • Veterinary Medicine (AREA)
  • High Energy & Nuclear Physics (AREA)
  • Optics & Photonics (AREA)
  • Computer Vision & Pattern Recognition (AREA)
  • Ultra Sonic Daignosis Equipment (AREA)
  • Apparatus For Radiation Diagnosis (AREA)
EP10805324.0A 2009-12-09 2010-11-30 Combination of ultrasound and x-ray systems Active EP2509507B1 (en)

Priority Applications (1)

Application Number Priority Date Filing Date Title
EP10805324.0A EP2509507B1 (en) 2009-12-09 2010-11-30 Combination of ultrasound and x-ray systems

Applications Claiming Priority (3)

Application Number Priority Date Filing Date Title
EP09306203 2009-12-09
EP10805324.0A EP2509507B1 (en) 2009-12-09 2010-11-30 Combination of ultrasound and x-ray systems
PCT/IB2010/055494 WO2011070477A1 (en) 2009-12-09 2010-11-30 Combination of ultrasound and x-ray systems

Publications (2)

Publication Number Publication Date
EP2509507A1 EP2509507A1 (en) 2012-10-17
EP2509507B1 true EP2509507B1 (en) 2018-04-04

Family

ID=43733562

Family Applications (1)

Application Number Title Priority Date Filing Date
EP10805324.0A Active EP2509507B1 (en) 2009-12-09 2010-11-30 Combination of ultrasound and x-ray systems

Country Status (7)

Country Link
US (1) US10238361B2 (zh)
EP (1) EP2509507B1 (zh)
JP (1) JP5795769B2 (zh)
CN (1) CN102651999B (zh)
BR (1) BR112012013706B1 (zh)
RU (1) RU2556783C2 (zh)
WO (1) WO2011070477A1 (zh)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102023104576A1 (de) 2022-05-30 2023-06-01 KOMBO medical solutions UG (haftungsbeschränkt) Verfahren zum Visualisieren und Modellieren von Zahnersatz
WO2023232384A1 (de) 2022-05-30 2023-12-07 Kombo Medical Solutions Ug Verfahren zum visualisieren und modellieren von zahnersatz

Families Citing this family (47)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
AU2012261998B2 (en) 2011-06-01 2017-03-02 Neochord, Inc. Minimally invasive repair of heart valve leaflets
EP2785256A4 (en) 2011-12-01 2016-03-30 Neochord Inc SURGICAL NAVIGATION FOR THE REPAIR OF CARDIAC VALVES
JP6207819B2 (ja) * 2012-09-20 2017-10-04 東芝メディカルシステムズ株式会社 画像処理装置、ｘ線診断装置及びプログラム
JP6297289B2 (ja) * 2012-09-20 2018-03-20 キヤノンメディカルシステムズ株式会社 画像処理システム、ｘ線診断装置及び画像処理装置の作動方法
CN113855059A (zh) 2012-11-06 2021-12-31 皇家飞利浦有限公司 增强超声图像
JP6482469B2 (ja) 2012-12-03 2019-03-13 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 超音波及びｘ線モダリティの統合
WO2014102718A1 (en) * 2012-12-28 2014-07-03 Koninklijke Philips N.V. Real-time scene-modeling combining 3d ultrasound and 2d x-ray imagery
WO2014115736A1 (ja) * 2013-01-22 2014-07-31 株式会社東芝 Ｘ線診断装置及び超音波診断装置
US20150223773A1 (en) * 2014-02-11 2015-08-13 Siemens Medical Solutions Usa, Inc. Method and Apparatus for Image Fusion Based Planning of C-Arm Angulation for Structural Heart Disease
EP2979642A4 (en) * 2013-03-29 2016-11-30 Hitachi Ltd IMAGE ALIGNMENT DISPLAY METHOD AND ULTRASONIC DIAGNOSTIC DEVICE
JP6397018B2 (ja) * 2013-11-25 2018-09-26 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 視野角最適化機能を持つ医療ビューイングシステム
US10026191B2 (en) * 2013-11-27 2018-07-17 Analogic Corporation Multi-imaging modality navigation system
WO2015101799A1 (en) 2013-12-30 2015-07-09 General Electric Company Medical imaging probe including an imaging sensor
CN106133797B (zh) * 2014-03-21 2021-03-02 皇家飞利浦有限公司 具有查看平面确定的医学查看系统
US11850083B2 (en) * 2014-05-16 2023-12-26 Koninklijke Philips N.V. Device for modifying an imaging of a tee probe in X-ray data
US10939881B2 (en) * 2014-06-17 2021-03-09 Koninklijke Philips N.V. Guidance device for a tee probe
US20160030008A1 (en) * 2014-07-30 2016-02-04 General Electric Company System and method for registering ultrasound information to an x-ray image
US10674933B2 (en) * 2014-10-22 2020-06-09 Biosense Webster (Israel) Ltd. Enlargement of tracking volume by movement of imaging bed
JP6505444B2 (ja) 2015-01-16 2019-04-24 キヤノンメディカルシステムズ株式会社 観察装置
CN104622496A (zh) * 2015-02-14 2015-05-20 刘长卿 超声波x线断层扫描装置
US10765517B2 (en) 2015-10-01 2020-09-08 Neochord, Inc. Ringless web for repair of heart valves
US9934570B2 (en) 2015-10-09 2018-04-03 Insightec, Ltd. Systems and methods for registering images obtained using various imaging modalities and verifying image registration
CN108289651B (zh) * 2015-11-25 2019-07-12 皇家飞利浦有限公司 用于跟踪身体部位中的超声探头的系统
EP3402408B1 (en) * 2016-01-15 2020-09-02 Koninklijke Philips N.V. Automated probe steering to clinical views using annotations in a fused image guidance system
RU2653807C2 (ru) * 2016-06-27 2018-05-14 Государственное бюджетное образовательное учреждение высшего профессионального образования "Санкт-Петербургский государственный педиатрический медицинский университет" Министерства здравоохранения Российской Федерации (ГБОУ ВПО СПбГПМУ Минздрава России) Способ дооперационной оценки лимфогенного метастазирования рака пищевода и желудка
JP6907247B2 (ja) 2016-06-30 2021-07-21 コーニンクレッカ フィリップス エヌ ヴェＫｏｎｉｎｋｌｉｊｋｅ Ｐｈｉｌｉｐｓ Ｎ．Ｖ． 光学的位置感知を使用する医療用ナビゲーション・システム及びその操作方法
CN109661684B (zh) * 2016-09-06 2023-03-28 维塔医疗股份公司 用于现实交互式超声模拟的射线追踪方法
EP3515288B1 (en) 2016-09-23 2021-06-23 Koninklijke Philips N.V. Visualization of an image object relating to an instrument in an extracorporeal image
CN109788940B (zh) * 2016-09-30 2022-12-02 皇家飞利浦有限公司 跟踪介入设备的特征
US10402969B2 (en) * 2017-03-10 2019-09-03 General Electric Company Methods and systems for model driven multi-modal medical imaging
US10213306B2 (en) 2017-03-31 2019-02-26 Neochord, Inc. Minimally invasive heart valve repair in a beating heart
EP3406195A1 (en) * 2017-05-24 2018-11-28 Koninklijke Philips N.V. Device and a corresponding method for providing spatial information of an interventional device in a live 2d x-ray image
EP3420914A1 (en) * 2017-06-30 2019-01-02 Koninklijke Philips N.V. Ultrasound system and method
EP3434192A1 (en) 2017-07-26 2019-01-30 Koninklijke Philips N.V. Registration of x-ray and ultrasound images
EP3482690A1 (en) * 2017-11-14 2019-05-15 Koninklijke Philips N.V. Ultrasound tracking and visualization
CN111989045A (zh) * 2018-03-19 2020-11-24 皇家飞利浦有限公司 多模态成像对准
EP3768176B1 (en) 2018-03-23 2024-03-20 NeoChord, Inc. Device for suture attachment for minimally invasive heart valve repair
US11253360B2 (en) 2018-05-09 2022-02-22 Neochord, Inc. Low profile tissue anchor for minimally invasive heart valve repair
US11173030B2 (en) 2018-05-09 2021-11-16 Neochord, Inc. Suture length adjustment for minimally invasive heart valve repair
JP7300198B2 (ja) 2018-09-07 2023-06-29 ネオコード インコーポレイテッド 低侵襲心臓弁修復のための縫合糸取付装置
JP7233874B2 (ja) * 2018-09-21 2023-03-07 キヤノンメディカルシステムズ株式会社 医用情報処理装置、ｘ線診断装置及び医用情報処理プログラム
EP3659514A1 (en) 2018-11-29 2020-06-03 Koninklijke Philips N.V. Image-based device identification and localization
JP6748254B2 (ja) * 2019-03-26 2020-08-26 キヤノンメディカルシステムズ株式会社 観察装置
CN114206265A (zh) 2019-04-16 2022-03-18 尼奥绰德有限公司 用于微创心脏瓣膜修复的横向螺旋心脏锚固器
RO135340A2 (ro) 2020-05-22 2021-11-29 Chifor Research S.R.L. Scanner 3d ultrasonografic, mod de realizare, utili- zare şi metoda de aliniere spaţială a scanărilor 3d din zona capului
US20220292655A1 (en) * 2021-03-15 2022-09-15 Canon Medical Systems Corporation Medical image processing apparatus, x-ray diagnostic apparatus, and method of medical image processing
EP4111982A1 (en) 2021-06-29 2023-01-04 Koninklijke Philips N.V. Systems and apparatuses for navigation and procedural guidance of laser leaflet resection under intracardiac echocardiography

Family Cites Families (19)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US5207225A (en) 1990-11-14 1993-05-04 Advanced Technology Laboratories, Inc. Transesophageal ultrasonic scanhead
JPH1115945A (ja) * 1997-06-19 1999-01-22 N T T Data:Kk 画像処理装置及び方法、及び、危険物検出システム及び方法
EP1204369A1 (en) * 1999-08-16 2002-05-15 Super Dimension Ltd. Method and system for displaying cross-sectional images of a body
US20020133077A1 (en) 2001-03-14 2002-09-19 Edwardsen Stephen Dodge Transesophageal ultrasound probe having a rotating endoscope shaft
US20050261591A1 (en) * 2003-07-21 2005-11-24 The Johns Hopkins University Image guided interventions with interstitial or transmission ultrasound
JP4315770B2 (ja) * 2003-09-30 2009-08-19 テルモ株式会社 体腔内治療診断システム
CN100473355C (zh) * 2003-12-22 2009-04-01 皇家飞利浦电子股份有限公司 用于把医疗仪器导入到病人体内的系统
US9237929B2 (en) * 2003-12-22 2016-01-19 Koninklijke Philips N.V. System for guiding a medical instrument in a patient body
US20060036162A1 (en) * 2004-02-02 2006-02-16 Ramin Shahidi Method and apparatus for guiding a medical instrument to a subsurface target site in a patient
US8126224B2 (en) * 2004-02-03 2012-02-28 Ge Medical Systems Global Technology Company, Llc Method and apparatus for instrument tracking on a scrolling series of 2D fluoroscopic images
EP2712553A3 (en) * 2005-01-11 2014-09-17 Volcano Corporation Vascular image co-registration
US7706860B2 (en) 2005-04-28 2010-04-27 Boston Scientific Scimed, Inc. Automated manipulation of imaging device field of view based on tracked medical device position
US20080146919A1 (en) * 2006-09-29 2008-06-19 Estelle Camus Method for implanting a cardiac implant with real-time ultrasound imaging guidance
US20080147086A1 (en) * 2006-10-05 2008-06-19 Marcus Pfister Integrating 3D images into interventional procedures
CN101541245B (zh) * 2006-11-22 2011-11-23 皇家飞利浦电子股份有限公司 x射线与血管内获取的数据的结合
US20080146942A1 (en) 2006-12-13 2008-06-19 Ep Medsystems, Inc. Catheter Position Tracking Methods Using Fluoroscopy and Rotational Sensors
US20090088628A1 (en) * 2007-09-27 2009-04-02 Klaus Klingenbeck-Regn Efficient workflow for afib treatment in the ep lab
DE102008005118B3 (de) * 2008-01-18 2009-09-17 Siemens Aktiengesellschaft Registrierungsverfahren
RU2372844C1 (ru) * 2008-06-16 2009-11-20 Общество с ограниченной ответственностью (ООО) "Кардиовид" Способ автоматического определения размеров и положения сердца пациента по флюорографическим снимкам

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102023104576A1 (de) 2022-05-30 2023-06-01 KOMBO medical solutions UG (haftungsbeschränkt) Verfahren zum Visualisieren und Modellieren von Zahnersatz
WO2023232384A1 (de) 2022-05-30 2023-12-07 Kombo Medical Solutions Ug Verfahren zum visualisieren und modellieren von zahnersatz

Also Published As

Publication number Publication date
US20120245458A1 (en) 2012-09-27
US10238361B2 (en) 2019-03-26
JP2013513412A (ja) 2013-04-22
WO2011070477A1 (en) 2011-06-16
EP2509507A1 (en) 2012-10-17
BR112012013706A2 (pt) 2018-01-23
JP5795769B2 (ja) 2015-10-14
RU2012128520A (ru) 2014-01-20
CN102651999B (zh) 2015-07-22
RU2556783C2 (ru) 2015-07-20
CN102651999A (zh) 2012-08-29
BR112012013706B1 (pt) 2021-10-13

Similar Documents

Publication Publication Date Title
EP2509507B1 (en) Combination of ultrasound and x-ray systems
EP2680755B1 (en) Visualization for navigation guidance
EP2099378B1 (en) Apparatus for determining a position of a first object within a second object
JP5345275B2 (ja) 超音波データと事前取得イメージの重ね合わせ
US8428690B2 (en) Intracardiac echocardiography image reconstruction in combination with position tracking system
JP4795099B2 (ja) 超音波を用いた電気解剖学的地図と事前取得イメージの重ね合わせ
JP5265091B2 (ja) ２次元扇形超音波イメージの表示
US8364242B2 (en) System and method of combining ultrasound image acquisition with fluoroscopic image acquisition
CA2614033C (en) Coloring electroanatomical maps to indicate ultrasound data acquisition
JP5622995B2 (ja) 超音波システム用のビーム方向を用いたカテーテル先端部の表示
US20160239963A1 (en) Tracking-based 3d model enhancement
US20090274271A1 (en) System and method for selecting a guidance mode for performing a percutaneous procedure
JP2018514352A (ja) 後期マーカー配置による融合イメージベース誘導のためのシステムおよび方法
US20140023250A1 (en) Medical imaging systen and method for providing an image representation supporting accurate guidance of an intervention device in a vessel intervention procedure
EP1727471A1 (en) System for guiding a medical instrument in a patient body
JP2006305359A (ja) 超音波輪郭再構築を用いた３次元心臓イメージングのためのソフトウエア製品
JP2006305358A (ja) 超音波輪郭再構築を用いた３次元心臓イメージング
EP2925232B1 (en) Integration of ultrasound and x-ray modalities
US10806520B2 (en) Imaging apparatus for imaging a first object within a second object
WO2011070492A1 (en) Visualization of ultrasound in x-ray images
US8467850B2 (en) System and method to determine the position of a medical instrument
AU2013251245B2 (en) Coloring electroanatomical maps to indicate ultrasound data acquisition
Housden et al. X-ray fluoroscopy–echocardiography

Legal Events

Date Code Title Description
PUAI Public reference made under article 153(3) epc to a published international application that has entered the european phase

Free format text: ORIGINAL CODE: 0009012

17P Request for examination filed

Effective date: 20120709

AK Designated contracting states

Kind code of ref document: A1

Designated state(s): AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

DAX Request for extension of the european patent (deleted)
RAP1 Party data changed (applicant data changed or rights of an application transferred)

Owner name: KONINKLIJKE PHILIPS N.V.

17Q First examination report despatched

Effective date: 20170403

REG Reference to a national code

Ref country code: DE

Ref legal event code: R079

Ref document number: 602010049720

Country of ref document: DE

Free format text: PREVIOUS MAIN CLASS: A61B0008000000

Ipc: A61B0006120000

GRAP Despatch of communication of intention to grant a patent

Free format text: ORIGINAL CODE: EPIDOSNIGR1

RIC1 Information provided on ipc code assigned before grant

Ipc: A61B 6/12 20060101AFI20171011BHEP

INTG Intention to grant announced

Effective date: 20171103

RIN1 Information on inventor provided before grant (corrected)

Inventor name: CATHIER, PASCAL Y. F.

Inventor name: GOGIN, NICOLAS P. B.

Inventor name: FLORENT, RAOUL

GRAS Grant fee paid

Free format text: ORIGINAL CODE: EPIDOSNIGR3

GRAA (expected) grant

Free format text: ORIGINAL CODE: 0009210

AK Designated contracting states

Kind code of ref document: B1

Designated state(s): AL AT BE BG CH CY CZ DE DK EE ES FI FR GB GR HR HU IE IS IT LI LT LU LV MC MK MT NL NO PL PT RO RS SE SI SK SM TR

REG Reference to a national code

Ref country code: GB

Ref legal event code: FG4D

REG Reference to a national code

Ref country code: CH

Ref legal event code: EP

REG Reference to a national code

Ref country code: AT

Ref legal event code: REF

Ref document number: 984676

Country of ref document: AT

Kind code of ref document: T

Effective date: 20180415

REG Reference to a national code

Ref country code: IE

Ref legal event code: FG4D

REG Reference to a national code

Ref country code: DE

Ref legal event code: R096

Ref document number: 602010049720

Country of ref document: DE

REG Reference to a national code

Ref country code: NL

Ref legal event code: MP

Effective date: 20180404

REG Reference to a national code

Ref country code: LT

Ref legal event code: MG4D

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: NL

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: AL

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: ES

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: PL

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: LT

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: SE

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: NO

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180704

Ref country code: BG

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180704

Ref country code: FI

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: GR

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180705

Ref country code: RS

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: LV

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: HR

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

REG Reference to a national code

Ref country code: AT

Ref legal event code: MK05

Ref document number: 984676

Country of ref document: AT

Kind code of ref document: T

Effective date: 20180404

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: PT

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180806

REG Reference to a national code

Ref country code: DE

Ref legal event code: R097

Ref document number: 602010049720

Country of ref document: DE

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: SK

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: DK

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: AT

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: EE

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: CZ

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: RO

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

PLBE No opposition filed within time limit

Free format text: ORIGINAL CODE: 0009261

STAA Information on the status of an ep patent application or granted ep patent

Free format text: STATUS: NO OPPOSITION FILED WITHIN TIME LIMIT

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: IT

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: SM

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

26N No opposition filed

Effective date: 20190107

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: SI

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

REG Reference to a national code

Ref country code: CH

Ref legal event code: PL

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: MC

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

Ref country code: LU

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20181130

REG Reference to a national code

Ref country code: BE

Ref legal event code: MM

Effective date: 20181130

REG Reference to a national code

Ref country code: IE

Ref legal event code: MM4A

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: LI

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20181130

Ref country code: CH

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20181130

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: IE

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20181130

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: BE

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20181130

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: MT

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20181130

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: TR

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: HU

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT; INVALID AB INITIO

Effective date: 20101130

Ref country code: MK

Free format text: LAPSE BECAUSE OF NON-PAYMENT OF DUE FEES

Effective date: 20180404

Ref country code: CY

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180404

PG25 Lapsed in a contracting state [announced via postgrant information from national office to epo]

Ref country code: IS

Free format text: LAPSE BECAUSE OF FAILURE TO SUBMIT A TRANSLATION OF THE DESCRIPTION OR TO PAY THE FEE WITHIN THE PRESCRIBED TIME-LIMIT

Effective date: 20180804

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: GB

Payment date: 20231121

Year of fee payment: 14

PGFP Annual fee paid to national office [announced via postgrant information from national office to epo]

Ref country code: FR

Payment date: 20231123

Year of fee payment: 14

Ref country code: DE

Payment date: 20231127

Year of fee payment: 14